局部与远端取穴治疗IBS腹痛的临床研究

发布时间：2018-06-06 13:41

  本文选题：肠易激综合征 + 弥散伤害抑制性控制　； 参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：大量的研究表明肠易激综合征(IBS)患者存在弥散性伤害性抑制性控制(DNIC)镇痛效应缺失,本研究旨在通过电针治疗以腹痛为主症的IBS,观察远端或局部取穴对IBS的镇痛效应,探讨在DNIC机制缺失导致全身内源性镇痛效应受损情况下,针刺镇痛的临床选穴规律。方法：该研究己获得广东省中医院伦理委员会的批准(伦理批件号：B2015-055-02),并在中国临床试验注册中心注册登记(登记号：ChiCTR-IPR-15006879)。招募对象为广东省中医院门诊以腹痛为主症的IBS患者,所有的志愿者均已签定知情同意书。本研究采用完全随机对照方法,将23名受试者随机分成四组：①局部穴位强刺激组(双侧天枢、外陵伤害性刺激)、②局部穴位弱刺激组(双侧天枢、外陵非伤害性刺激)、③远端穴位强刺激组(双侧足三里、上巨虚伤害性刺激)、④远端穴位弱刺激组(双侧足三里、上巨虚非伤害性刺激)。强刺激(伤害性刺激)：100%≤痛阈≤130%；弱刺激(非伤害性刺激)：50%≤痛阈≤80%。针刺深度为1-1.5寸,以得气为宜,采取疏密波(2／100Hz),留针30min,疗程为2-3次/周,每隔2-3天1次,7次为一个疗程,共两个疗程。疗效评价指标：压力痛阈(每次治疗前后均采用痛阈测定仪Vonfrey测定3次,取平均值),腹痛和IBS-SSS评分(均在治疗前、第一、二次疗程结束后、治疗后3个月测定)。结果：本试验预计招收40人,实际纳入23人,年龄在21-50岁之间,病程约在2-11年之间。患者基线特征的可比性分析中,两组年龄、病程、痛阈、腹痛分数、IBS-SSS评分等经分析均无统计学意义(p＞0.05),说明两组间的基线资料具有可比性。1)痛阈：组内比较：局部穴位强刺激组和局部穴位弱刺激组在第一、二个疗程结束后痛阈较治疗前明显升高(P0.05)；组间比较：局部选穴对痛阈的影响与远端选穴对比有明显差异(P0.01)；2)腹痛评分：组内比较：在第一、二个疗程结束后,局部穴位强刺激组、局部穴位弱刺激组的腹痛评分较前明显下降(P0.01)；治疗结束后3个月,局部穴位强刺激组(P0.05)、局部穴位弱刺激组(P0.01)的腹痛评分较第二个疗程结束后均明显升高；组间比较：局部选穴对腹痛的影响与远端选穴对比有明显差异(P0.01)；3) IBS-SSS评分：组内比较：在第一、二个疗程结束后,四组的IBS-SSS评分均较前明显下降(p0.05)。结论：局部取穴无论是伤害性或非伤害性刺激对治疗IBS腹痛均有良好的镇痛效果,而远端取穴对IBS无明显镇痛效果,提示在DNIC缺失导致内源性镇痛系统受损情况下,针刺镇痛宜以局部选穴为主。
[Abstract]:Objective: to investigate the analgesic effect of diffuse nociceptive inhibitory control (DNIC) in patients with irritable bowel syndrome (IBS) by electroacupuncture, and to observe the analgesic effect of distal or local acupoints on IBS. To explore the clinical selection rule of acupuncture analgesia under the condition that the absence of DNIC mechanism leads to the damage of systemic endogenous analgesia. Methods: the study has been approved by the Ethics Committee of Guangdong Provincial traditional Chinese Medicine Hospital (Ethics lot No.: B2015-055-02U) and registered with China Clinical trial Registration Center (10 ChiCTR-IPR-15006879). The subjects were IBS patients with abdominal pain in outpatient clinic of Guangdong traditional Chinese Medicine Hospital. All the volunteers had signed informed consent form. In this study, 23 subjects were randomly divided into four groups (bilateral Tianshu, Wuling nociceptive stimulation and weak stimulation group). Wuling non-nociceptive stimulation group (bilateral Zusanli group, Shangjuxu nociceptive stimulation group) (bilateral Zusanli group, Shangjuxu non-nociceptive stimulation group). Strong stimulation (nociceptive stimulus 100% 鈮，

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